Management of Extremity Venous Thrombosisin Neonates and Infants: An ExperienceFrom a Resource Challenged Setting

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تاريخ نشر الرسالة :

اسم الباحث :

Ahmed Mousa, MD, FRCS, FACS1,2 , Ossama M. Zakaria, MD2,3,Ibrahim Hanbal, MD1, Mohammed A. Nasr, MD4, Tamer A. Sultan, MD5,Mohamed Abd El-Hamid, MD1, Amr M. El-Gibaly, MD6, Haytham Al-Arfaj, SB2,Ahmed S. Daha, MD1, Mohammed A. Buhalim, SB2, Mohamed Y. Zakaria, MD1,Dina E. El Metwally, MD7, Bosat E. Bosat, MD8, Alaa Sharabi, MD1,Mohamed Nienaa, MD2, Mahsoub M. Amin, MD1, and Khaled A. Rashed, MD9

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ملخص عن الرسالة :

We aimed to evaluate the outcome of different treatment modalities for extremity venous thrombosis (VT) in neonates andinfants, highlighting the current debate on their best tool of management. This retrospective study took place over a 9-year periodfrom January 2009 to December 2017. All treated patients were referred to the vascular and pediatric surgery departments fromthe neonatal intensive care unit. All patients underwent a thorough history-taking as well as general clinical and local examinationof the affected limb. Patients were divided into 2 groups: group I included those who underwent a conservative treated with thesole administration of unfractionated heparin (UFH), whereas group II included those who were treated with UFH plus warfarin.Sixty-three patients were included in this study. They were 36 males and 27 females. Their age ranged from 3 to 302 days. Fortyone (65%) patients had VT in the upper limb, whereas the remaining 22 (35%) had lower extremity VT. The success rate of thenonsurgical treatment was accomplished in 81% of patients. The remaining 19% underwent limb severing, due to establishedgangrene. The Kaplan-Meier survival method revealed a highly significant increase in both mean and median survival times in thosegroups treated with heparin and warfarin compared to heparin-only group (P < .001). Nonoperative treatment with anticoagulation or observation (ie, wait-and-see policy) alone may be an easily applicable, effective, and a safe modality for managementof VT in neonates and infants, especially in developing countries with poor or highly challenged resource settings.

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